This project addresses the need to develop an effective and efficient system to respond to the high volume of telephone requests for medical advice to ambulatory pediatric settings. During the current year, the demand for service via the telephone has been assessed at three pediatric settings (a pediatric hospital emergency service, an HMO, and a suburban private group practice), and problem-oriented protocols (clinical algorithms) have been developed to respond to the majority of chief complaints which are presented over the telephone. Paramedical personnel (health assistants) have been trained to administer these protocols. The protocols and the system are undergoing field testing to determine whether they meet patient needs and to study their safety, reliability, and validity. During the second year of the study, the protocol/health assistant system will be evaluated in the Children's Hospital Medical Center emergency room by comparing the new system to the current, relatively unorganized system of responding to calls. A series of randomized clinical trials will be conducted, with measures of efficiency, quality of care, and patient satisfaction as the dependent variables.